Cleaveland: Questions on tragedy still remain

On Tuesday, April 16, I was privileged to attend the celebration at the Tivoli Theater for young writers in our schools. The first hour honored boys and girls from kindergarten to fifth grade.

They lined up at the foot of the stage, many dressed in their holiday best, until their names were called to walk to the podium to receive a medal, a handshake and applause. A little girl in a red dress acknowledged her plaudits with a curtsy. They came from across our community's economic and racial landscape. Peace and goodwill reigned. The aspirations of a civil society were affirmed.

A day earlier, a tragedy that still defies comprehension struck Boston near

the finish line of its legendary marathon. Two bombs exploded; an 8-year-old boy among three fatalities. Other children were among the wounded.

After each attack on innocent people, I search for answers.

Are there among us persons for whom violence is an inalterable, lifelong pattern of behavior? Throughout my first years of school, my classmates and I feared an older boy held back for several years. He repeatedly threatened and bullied us on playgrounds. In eighth grade he finally exploded, beating a fellow student brutally between classes. He disappeared following expulsion from school.

During a psychiatry rotation at a Maryland penal facility, a medical school classmate and I interviewed a serial killer, a man seemingly without any human sympathy. His soft-spoken demeanor fooled us initially. When our mentor subsequently confronted the man with his crimes, the killer simply smiled.

One of my military duties at Fort Knox involved daily rounds with prisoners in the stockade. Two young men, awaiting trial for murders, were too violent to be examined unless forcibly restrained. Outbursts of rage marked their waking hours.

Weekend rotations in the emergency room involved treating victims of beatings fueled by alcohol, drugs and racial prejudice, each of which can dissolve restraints to aggression.

Does frequent exposure to violent video games, movies, and television programs tip vulnerable young people toward extreme behavior? Gore and death are staples in such entertainments. Can this exposure desensitize a participant to real human suffering?

Does repeated exposure to extreme religious and political ideology have similar effects?

The studies of nerve circuits by Nobel Prize winner Eric Kandel demonstrate that repeated stimulation leads to increases in structure and function of affected neurons. Imagine behavioral circuits in our brains being similarly affected to predispose us to aggressive thoughts and actions.

Psychiatrist James Gilligan contends in his 1996 book, "Violence: Our Deadly Epidemic and Its Causes," that shame is a major factor in driving an epidemic of rage among men. His theory is based upon years as medical director of a Massachusetts state hospital for criminally insane. Men can develop an exaggerated sense of personal honor and, in tough circumstances, this honor may be all a young man clings to for identity. Assaults on that honor may lead to violent revenge. The author's case reports are chilling and instructive.

"Raising Cain: Protecting the Emotional Life of Boys" by Dan Kindlon and Michael Thompson offers practical assessments and advice for parents and teachers on the care and upbringing of boys. Among the sources in which I've searched for answers to the causes and prevention of violence, this is the most valuable.

As a society, we must define and address the precursors of violence. A national panel of inquiry appointed by the president is a logical starting place.